Cervical cancer is a common gynecological malignant tumor, and its incidence in menopausal and perimenopausal women is closely related to persistent human papillomavirus (HPV) infection, weakened immune function, chronic cervical inflammation, and long-term unhealthy living habits. During menopause, women’s ovarian function declines, estrogen levels decrease, which may reduce the stimulation of cervical epithelial cells, but for patients already diagnosed with cervical cancer, timely and standardized treatment is still crucial. The treatment of cervical cancer during menopause adheres to the principles of individualization and comprehensiveness, combining local treatment, systemic treatment, and minimally invasive treatment, with focused ultrasound ablation as a key added non-invasive option. The specific treatment plan needs to comprehensively consider the patient’s age, tumor stage, pathological type, general health status, and whether there are complications such as hypertension and diabetes.
1. Surgery Treatment
Surgery is the main treatment method for early-stage (stage I-IIA) cervical cancer in menopausal women, aiming to remove the tumor tissue and surrounding affected tissues to achieve radical cure. Commonly used surgical methods include radical hysterectomy combined with pelvic lymph node dissection, simple hysterectomy, and trachelectomy (rarely used in menopausal patients). Radical hysterectomy removes the uterus, cervix, upper vagina, and surrounding connective tissue, along with pelvic lymph node dissection to clarify the extent of lymph node metastasis and reduce the risk of recurrence. Since menopausal women have no fertility needs, radical hysterectomy is the preferred surgical method for early-stage cervical cancer. For elderly patients with poor physical condition or comorbidities who cannot tolerate radical surgery, simple hysterectomy can be considered to remove the primary tumor and relieve symptoms. In addition, for patients with small tumors and good physical condition, minimally invasive surgical methods such as laparoscopic or robotic radical hysterectomy can be used, which have the advantages of less trauma, less bleeding, and faster recovery.
2. Radiotherapy
Radiotherapy is an important local treatment method for cervical cancer, suitable for middle and advanced-stage (stage IIB-IV) patients, patients who cannot tolerate surgery, or patients with residual tumor tissue after surgery. It uses ionizing radiation to kill tumor cells and residual cancer cells, achieving the purpose of controlling the disease and relieving symptoms. Radiotherapy for menopausal cervical cancer includes external beam radiotherapy and intracavitary brachytherapy. External beam radiotherapy is mainly used to irradiate the pelvic cavity to eliminate large-scale tumor tissue and lymph node metastasis, while intracavitary brachytherapy is used to irradiate the cervix and vaginal vault to enhance the local radiation dose and improve the treatment effect. Postmenopausal patients have relatively weakened tolerance to radiotherapy, so the radiation dose and course of treatment need to be adjusted according to the patient’s physical condition, and supportive treatment such as nutritional support and anti-inflammatory treatment should be strengthened to reduce side effects such as radiation dermatitis, pelvic inflammation, and gastrointestinal reactions.
3. Focused Ultrasound Ablation (High-Intensity Focused Ultrasound, HIFU) – Key Minimally Invasive Treatment
Focused Ultrasound Ablation (HIFU) is a safe, effective, and non-invasive minimally invasive treatment that has become an important supplementary option for the treatment of menopausal cervical cancer, especially suitable for elderly patients with poor physical condition, those who cannot tolerate surgery or radiotherapy, or those with early-stage small tumors who refuse traditional invasive treatment. It uses high-intensity focused ultrasound energy to penetrate the skin and normal pelvic tissues, accurately focus on the cervical cancer lesion, and generate high temperature (60-100℃) at the focal point to coagulate and necrose the tumor cells. After the tumor tissue is necrosed, it will be gradually absorbed and eliminated by the body’s immune system, thereby achieving the purpose of shrinking the tumor, controlling the disease progression, and relieving symptoms such as irregular vaginal bleeding and pelvic pain.
Compared with traditional surgery and radiotherapy, HIFU has obvious advantages for menopausal patients: First, it is non-invasive, with no incision, no bleeding, and no risk of infection, which greatly reduces the physical trauma to patients and shortens the recovery period. Elderly patients can resume normal daily life soon after treatment without being bedridden for a long time. Second, it avoids the damage to surrounding normal tissues (such as the bladder, rectum, and ovaries) caused by surgery and radiotherapy, reducing the risk of complications such as urinary incontinence and intestinal obstruction. Third, the treatment process is painless and does not require general anesthesia, which reduces the risk of anesthesia-related complications, making it more suitable for patients with underlying diseases such as hypertension, diabetes, and coronary heart disease. Fourth, the treatment effect is accurate. For early-stage small cervical cancer lesions (less than 4cm), the ablation rate can reach more than 85%, which can effectively control the tumor and reduce the risk of local recurrence. Fifth, it has good compatibility with other treatments. HIFU can be used in combination with radiotherapy, chemotherapy, or immunotherapy to improve the overall treatment effect, especially for patients with residual tumors after surgery or radiotherapy. It should be noted that HIFU is mainly suitable for early-stage cervical cancer with small lesions, no extensive lymph node metastasis, and no distant metastasis. For patients with large lesions, extensive lymph node metastasis, or advanced cervical cancer, HIFU is usually used as a palliative treatment to relieve symptoms and improve the quality of life.
4. Chemotherapy
Chemotherapy is a systemic treatment method that uses cytotoxic drugs to kill tumor cells or inhibit their proliferation, mainly used for middle and advanced-stage cervical cancer, recurrent or metastatic cervical cancer, or as an adjuvant treatment before or after surgery/radiotherapy. Commonly used chemotherapy drugs include cisplatin, paclitaxel, and carboplatin, which are usually used in combination to improve the treatment effect. For menopausal patients, due to weakened physical function and poor tolerance, the chemotherapy dose and cycle need to be adjusted according to the patient’s physical condition, and supportive treatment such as antiemetic, blood transfusion, and nutritional support should be strengthened to reduce side effects such as myelosuppression, gastrointestinal reactions, and hair loss. Chemotherapy can effectively shrink the tumor, control distant metastasis, and prolong the survival time of patients with advanced cervical cancer.
5. Targeted Therapy and Immunotherapy
Targeted therapy and immunotherapy are new precise treatment methods for cervical cancer, providing new options for menopausal patients with advanced or recurrent cervical cancer. Targeted therapy targets specific molecular targets of tumor cells, such as vascular endothelial growth factor (VEGF) and epidermal growth factor receptor (EGFR), and uses targeted drugs to block the growth and metastasis of tumor cells. For example, bevacizumab is a common targeted drug for cervical cancer, which can inhibit tumor angiogenesis and slow down tumor progression. Immunotherapy uses the body’s own immune system to recognize and kill tumor cells, such as programmed death receptor 1 (PD-1) inhibitors and programmed death ligand 1 (PD-L1) inhibitors, which can enhance the immune response of the body to tumor cells and improve the treatment effect. Postmenopausal patients can benefit from targeted therapy and immunotherapy, but before treatment, relevant molecular detection is needed to determine whether they are suitable for treatment, and the treatment process needs to be closely monitored for side effects.
In summary, the treatment of cervical cancer during menopause is a comprehensive process that needs to combine the patient’s specific situation to formulate an individualized treatment plan. Surgery and radiotherapy are the traditional core treatment methods for early and middle-stage cervical cancer, while chemotherapy, targeted therapy, and immunotherapy are important supplements for advanced and recurrent diseases. Focused ultrasound ablation, as a non-invasive, minimally invasive treatment, provides a safer and more tolerable choice for menopausal patients, especially the elderly and those with poor physical condition, effectively relieving symptoms and improving the quality of life. No matter which treatment method is chosen, regular follow-up after treatment is necessary, including gynecological examination, cervical cytology, HPV detection, and imaging examination, to monitor the recovery of the condition, detect recurrence and metastasis in time, and improve the survival rate and quality of life of patients.